Smokeless Tobacco Products as a Harm-Reduction Mechanism: A Research Agenda

Increased awareness of the dangers of cigarettes has failed to prevent millions of Americans from continuing to smoke. Thus, policy makers should consider viable options to reduce the harmful effects of smoking. Among the proposed options is increasing public awareness of the relative health risk of smokeless tobacco in comparison with cigarettes. Compelling scientific evidence indicates that smokeless tobacco is considerably less harmful than cigarettes. Therefore, innovative approaches to nicotine replacement, such as smokeless tobacco, may provide an effective means of reducing the overall harm associated with smoking and ultimately may reduce smoking prevalence in the United States. The underlying principle of harm reduction is that a product that has adverse health consequences is promoted as a substitute for one that has more severe adverse health consequences. As a result, the authors review the relevant literature and put forth a research agenda to advance this notion of tobacco harm reduction. The policy debate would be enhanced by evidence of the constructs and relationships outlined in the proposed model. Specifically, the authors discuss five particular areas of needed research.